The sensory disorder had another distribution, objectively tested. The sacral and perineal regions were free. Anesthesia of inner surfaces of thighs, hypesthesia of the anterior surfaces of thighs and lower legs. The anesthesia grew more and more marked lower down and was maximal in the feet, which were practically insensible to all tests, including those for bone sensation. There was a longitudinal strip of skin of lower leg which retained sensation.
Position sense of toes, except great toes, was poor. There was a slight ataxia attributable to the sensory disorder--reflexes of upper extremities, abdominal, and cremasteric preserved, knee-jerks, Achilles and plantar reactions absent.
The vesical sphincter shortly regained its function, though its disorder had been an initial symptom. Pupils normal.
The “sciatica” here affects the lumbosacral plexus.
As to the syphilitic nature of this affection, there had been at eighteen (22 years before) a colorless small induration of the penis, lasting about three weeks. There was now evident a small oval pigmented scar. The patient had married at 20 and had had three healthy children.
The lumbar puncture fluid yielded pleocytosis (120 per cmm.). Mercurial treatment was instituted.
The treatment has not reduced the pains. Long thinks it was undertaken too long (six months) after onset. The warning for early diagnosis is manifest. There was somehow a delay under the medical conditions of the army.
_Re_ syphilis in munition-workers Thibierge has much to say of French conditions. Throughout his work on syphilis in the army, he stresses the large number of venereal cases in men mobilized for munition-work. Medical inspections ought, according to Thibierge, imperatively to be made in the munition-works and upon all mobilized workmen, whether French or belonging to the Colonial contingents. These men are under military control in France, but they have more opportunities than the soldiers for contracting and disseminating syphilis. They are, in point of fact, very often infected and in a higher proportion than are the soldiers at the front. The munition-workers should also be obliged to report their infections to the physician, whether or no they are under treatment by military or by private physicians.
